硬膜外腔注入利多卡因对血清细胞因子的影响  

Effects of Perioperative Epidural Lidocaine on Serum Cytokine in Patients undergoing Upper Abdominal Surgery

作　　者：史载祥[1] 刘功俭[2] 李茂琴[1] 王建华[1] 

机构地区：[1]徐州市第四人民医院ICU,徐州市221009 [2]徐州医学院附属医院麻醉科,徐州市221009

出　　处：《医药论坛杂志》2006年第11期1-3,6,共4页Journal of Medical Forum

摘　　要：目的观察硬膜外麻醉及术后硬膜外腔持续注入利多卡因对上腹部手术患者围术期血清TNF-α、IL-1、IL-4、IL-6变化的影响。方法36例择期上腹部手术患者,随机分为硬膜外麻醉加术后硬膜外腔注入利多卡因组(Ⅰ组,n=12),全麻加术后硬膜外腔注入利多卡因组(Ⅱ组,n=12)和全麻加术后硬膜外腔注入生理盐水组(Ⅲ组,n=12)。分别于术前0.5h、术后0h、24h和48h抽取血样测定白细胞计数(WBC)及血清TNF-α、IL-1、IL-4、IL-6浓度。同时记录体温(T)、心率(HR)和平均动脉压(MAP)。结果①各组患者体温、心率变化均不明显(P>0.05);平均动脉压变化:Ⅱ组术后0h及Ⅲ组术后0h、24h较术前明显增高;白细胞计数变化:3组患者白细胞计数术后0h均较术前明显升高(P<0.01),Ⅱ、Ⅲ组较Ⅰ组亦明显升高(P<0.01),随后均下降,术后24hⅢ组明显高于Ⅱ组。②3组TNF-α、IL-1在各时点均逐渐上升,术后0hⅡ组TNF-α明显高于Ⅰ组,术后24h、48hⅢ组TNF-α、IL-1均明显高于Ⅰ组,术后48hⅢ组IL-1明显高于Ⅱ组;3组IL-6水平术后0h均为最高,其中Ⅰ组变化无统计学意义,Ⅱ、Ⅲ组明显高于术前;3组IL-4水平术后0h均为最低,在术后的上升过程中,Ⅲ组较慢,术后48h明显低于Ⅰ组。结论硬膜外麻醉及术后硬膜外腔持续注入利多卡因可有效抑制促炎细胞因子的释放,术后硬膜外腔注入利多卡因尚可促进术后抑炎细胞因子的上升。Objective To investigate the effects of epidural anesthesia and postoperative epidural lidocaine on perioperitive serum TNF -α, IL - 1, IL -4 and IL -6 in the patients undergoing upper abdominal surgery. Methods 36 patients undergoing elective upper abdominal surgery were allocated randomly to epidural anesthesia ＋ postoperative epidural lidocaine group （ group Ⅰ , n = 12 ）, general anesthesia ＋ postoperative epidural lidocanine group（ group Ⅱ , n = 12） and general anesthesia ＋ postoperative epidural NS group（group Ⅲ, n = 12）. Blood samples were taken 0. 5h before operation ,Oh 24h and 48h following operation for determination of WBC ,serum levels of TNF -α ,IL - 1 ,IL -4 and IL -6 and T,HR and MAP were monitored meanwhile. Results ①There were no significant statistic difference in T and HR of all patients （ P 〉 0. 05 ）. MAP Oh after operation in group Ⅱ and Oh ,24h after operation in group Ⅲ were significantly higher than that 0.5h before operation. WBC 0h after operation were significantly higher than those 0. 5h before operation in all 3 groups（ P 〈0.01 ） , those in group Ⅱ and m were significantly higher than that in group Ⅰ （ P 〈0. 01 ） ,then they gradually decreased ,24h after operation that in group Ⅲ was significantly higher than that in group Ⅱ. ②TNF-α and IL- 1 were gradually increased in all 3 groups,0h after operation TNF-α in group ]1 was significantly higher than that in group Ⅰ ,24h ,48h after operation TNF -α and IL - 1 in group m were significantly higher than that in group Ⅰ, 48h after operation IL - 1 in group Ⅲ was significantly higher than that in group Ⅱ ; In group H and m, the serum concentrations of IL -6 0h following operation were sgnificantly higher than that 0.5h before operation （ P 〈 0.05 ） ;the serum concentration of IL-4 increased slowly in group Ⅲ after operation,48h after operation that in group Ⅲ was significantly lower than that in group Ⅰ. Conclusion Epidural anesthesia and postoperative epidu

关 键 词：麻醉全身硬 膜外利 多卡因 TNF-Α IL-1 IL-4 

分 类 号：R614.2[医药卫生—麻醉学]